an exploratory study of traumatology rotations - Preprints

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May 11, 2018 - Wigton RS, Blank LL, Nicolas JA, Tape TG. Procedural skills training in internal medicine residencies. A survey of program directors. Ann Intern ...
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 11 May 2018

doi:10.20944/preprints201805.0174.v1

MISMATCH BETWEEN STUDENT AND TUTOR EVALUATION OF TRAINING NEEDS: AN EXPLORATORY STUDY OF TRAUMATOLOGY ROTATIONS Fernando Santonja-Medina1, María Paz García-Sanz2, Sara Santonja-Renedo, Joaquín García-Estañ3 Departamentos de Traumatología1, Educación2 y Fisiología3, Hospital Clínico Universitario Virgen de la Arrixaca1, Instituto Murciano de Investigación Biomédica1,3, Centro de Estudios en Educación Médica1,3, Facultad de Medicina, Universidad de Murcia, Murcia, Spain Corresponding author: Joaquín García-Estañ, Centro de Estudios en Educación Médica, Facultad de Medicina, Campus de El Palmar, 30120 Murcia, Spain. Phone: 34-868-884880, Fax: 34-868-884150, E-mail: [email protected] Authors’ emails: Fernando Santonja-Medina: [email protected], M. Paz García-Sanz: [email protected].

Abstract Clinical training in medical schools in Spain is performed by rotations in university hospitals. During these internships, students are expected to acquire and master basic procedural skills. However, the assessment tools available rarely check whether these skills are completely acquired by the students. We have used an e-portfolio to determine the optimal number of times the students need to repeat a procedure to be able to perform it independently. The results were compared with the actual performance during the internships. An e-portfolio collected qualitative information about the internships. Quantitative information was also requested about the number of times each clinical skill was performed. Later, a survey asked these students and their teachers the optimal number of times each skill should be repeated before it could be considered fully acquired. The questionnaire was answered by 98.6% of the students and 70.3% of their teachers. Out of the 21 clinical skills and procedures selected, both students and their tutors agreed in a similar optimal value in 16 of them; only in five of them, teachers thought that students needed a greater number of times than that selected by the students. When these optimal values were compared with the actual values recorded in the portfolio during the internships, it was found that about half of the clinical skills were carried out less frequently than expected, thus providing an important feedback about the internships. Quantitative information collected in portfolios reveals a moderate mismatch between students and tutors perceptions of their training needs. Keywords: e-portfolio, clinical skills, competences, medicine

Introduction The idea that doctors are competent to work with patients immediately after graduation has been luckily abandoned during the last decades (1). In fact, a very low positive correlation between outcomes in written tests and examinations and the actual clinical practice has been demonstrated (2-5). In Spain, the entrance to the postgraduate training (specialization) is granted based on the scores obtained in a multiple choice test (MIR examination) that mainly assess the theoretical knowledge level. Some clinical skills like reading X-ray images or EKGs are also included, as well as clinical cases, but a comprehensive OSCE-type assessment is not among the priorities of the organizers, the Health Ministry, the authority that controls the MIR examination (6-7). Thus, it is not without surprise that the training of medical students in the medical schools has traditionally lacked a serious clinical training, in which even a list of minimum skills and clinical maneuvers is missing and the student is treated frequently as a hospital tourist (8). 1

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Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 11 May 2018

doi:10.20944/preprints201805.0174.v1

Things are slowly changing since the adoption of a system based on the training in clinical competences (9) and the adoption of assessment tools such as OSCEs in medical schools (10-11). While some of these competences are related to medical knowledge, that is the theoretical background, many of them, specially those clinical competences relative to clinical skills and procedures (12) require a different mechanism to teach and learn them and, more importantly, to consider them sufficiently acquired. These clinical competences, therefore, need time to be learned and also need repetition before deciding if a student is able to perform those tasks with autonomy and, therefore, to consider that he/she has acquired the corresponding learning oucome (13-14). However, determining what is the optimal number of times that the students need to repeat a procedure to be competent enough to perform it independently remains a challenge in undergraduate medical education (15). But, some studies has been carried out to determine these numbers in postgraduate medical education, for internal medicine or surgery residents (16-20). In a previous paper, we presented evidence that a reflexive portfolio is an important tool to analyze the acquisition of traumatology competences of medical students (21). In that work, the teachers assessed the level of acquisition of clinical competences by reading critically all the portfolios, but this was done qualitatively, without taking into account the number of times the different skills were carried out. With this in mind, we have modified our portfolio in several aspects. First, we have made an electronic version, which makes easier the process of portfolio assessment. Secondly, we have implemented measures to determine the number of times that the student performs each skill and compared it to the values obtained by surveying these own students and also their teachers. Material and Methods We have used an updated version of our portfolio previously described (21), and that it is used to assess the competences and learning outcomes assigned to Traumatology in the curriculum of the Medical Degree at the University of Murcia. Basically, the portfolio is now an electronic portfolio (e-portfolio), designed with two different sections. The first is a qualitative part where the students describe the activity carried out, highlight what they have learned and make reflections about the most remarkable aspects of their internship. The second section is the quantitative part, where they mark in a series of boxes the number of times the different learning tasks are carried out. These learning tasks are 21, related to the five competences that are evaluated with the e-portfolio (5 competencies). Students fill up the eportfolio while they assist to its Traumatology internship, consisting of a mandatory 10-day rotation (four days in outpatient appointments, four days in the operating room and two days in the emergency room). This activity is necessary in order to pass the discipline and it accounts for 10% of the final result. The number of students registered was 215 and all of them had personal and private access to the e-portfolio, located in a server of the Universidad de Murcia (http://practicum-med.inf.um.es/portfolio/). Close to the end of the academic year, once the clinical skills exam was carried out, we administered a questionaire to all these students and ask them about the number of times they consider each skill should be repeated to consider that they have have acquired the corresponding outcome. The questionnaire was answered by 212 of the 215 students enrolled (98.6%). This questionnaire was also administered to the tutors of the internship, being answered by 52 out of 74 (70.3%). Statistical analysis. Data analysis was performed with the Statistical Package for the Social Sciences (SPSS), version 19. Means and standard deviations were obtained to describe the results and the statistical significance between means was performed by means of an ANOVA. A p value lower than 0.05 was considered to be statistically significant. Results Table 1 shows the comparison between the estimated number of times that the students and their tutors think it is necessary to repeat a procedure or skill in order to consider effectively acquired each learning task. Most of the values (16 out of 21) considered 2

Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 11 May 2018

doi:10.20944/preprints201805.0174.v1

by students and tutors were very similar in both cases, except for five of them, where tutors statistically consider that students should repeat them many more times. Table 1. Optimal number of times that students and teachers think it is necessary to repeat a procedure or skill to be able to achieve the learning outcome.*, p